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Lecture Images Flashcards

1
Q
A

Note: no sensory distribution for C1

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2
Q

Winged scapula

(a) Muslce involved
(b) Nerve injured

A

Winged scapula due to injury to (b) Long thoracic causing loss of innervation to the (a) serratus anterior

SALT = serratus anterior, long thoracic

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3
Q

Nerve controlling

(a) Foot dorsiflexion
(b) Foot plantar flexion

A

(a) Dorsiflexion by the deep peroneal nerve
(b) Plantar flexion by the tibial nerve

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4
Q

What malignancy should be screened for in a pt w/ distal peripheral neuropathy w/o diabetes?

A

Screen for multiple myeloma

-also chronic alcoholism can cause stocking-and-glove distribution peripheral neuropathy

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5
Q

What are the two main branches fo the sciatic nerve?

A

Before going thru the popliteal fossa the sciatic nerve splits into the common peroneal/fibular nerve and the tibial nerve

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6
Q

The belt might cause injury to what nerve? How would this present?

A

Injury to lateral femoral cutaneous nerve

-tingling/numbness/burning in outer thigh

2/2 tight clothing, obesity/wt gain, pregnancy

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7
Q

Purpose of tPA

A

Save the penumbra- tissue that is ischemic but not yet infarcted

-takes 90 minutes on average to set up the IR suite => give tPA in the mean time to save penumbra

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8
Q

Baby pulled out of birth canal by arm is at risk for what?

A

Klumpke’s palsy (claw hand deformity) 2/2 damage to C8-T1

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9
Q

Name the 4 most common locations for white matter lesions in MS

A
  1. Periventricular
    - look like Dawson’s fingers on sagittal view
  2. Juxtacortical
  3. Infratentorial (posterior fossa)
    - brainstem and cerebellum
  4. spinal cord
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10
Q

Where may jaw pain radiate? Why?

A

Jaw pain sometimes radiates to the ear b/c both are of the C2 dermatome

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11
Q

Dx

A

Left ACA stroke

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12
Q

2 findings on MRI

Dx

A

Dx = neuromyelitis optica = Devic’s disease = simultaneous inflammation and demyelination of the optic nerve and spinal cord

  • on a spectrum w/ MS
  • inflammatory disease that presents w/ pathology of the optic nerve/chiasm
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13
Q

What nerve innervates the

(a) Quadriceps
(b) Hamstring
(c) Gluteus maximus

A

(a) Femoral nerve innervates the quadricep
(b) Sciatic nerve innervates the hamstring
(c) Inferior gluteal nerve innervates the gluteus maximus

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14
Q

Precentral vs. postcentral gyrus

A

Precental = primary motor cortex

Postcentral = primary sensory cortex

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15
Q

(a) Finding
(b) Dx

A

(a) Finding = juxtacortical lesion
(b) MS

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16
Q

48 yo POD1 from bifrontal meningioma removal, uncomplicated postop but now somnolent

(a) Dx
(b) Mgmt

A

(a) Dx = bitemporal tension pneumocephalus (air in the head)
(b) Mgmt = bed flat
- 100% oxygen to diffuse out the nitrogenous air
- needle decompression
- consider bifrontal craniectomy if need to

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17
Q

Name the two reflexes tested in the lower extremity

(a) What nerve roots innervate these reflexse?

A
  1. achilles innervated by S1/S2
  2. patellar reflex innervated by L3/L4
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18
Q

Pt cannot extend his leg at the knee- which nerve is injured?

A

Can’t extend knee = inability to control quadricep muscle = injury to femoral nerve

19
Q

Baby pulled out of birth canal by head is at risk for what?

A

Erb’s palsy (waiter’s tip deformity) due to damage to C5-C6

20
Q

Dermatomal landmarks

(a) Bellybutton
(b) Nipple line
(c) Thumb

A

(a) Bellybutton = T10
(b) Nipple line = T4
(c) Thumb = C6 (thumb’s up)

21
Q

Injury to what nerve causes wrist drop

A

Injury to radial nerve which innervates the muscles that extend the wrist (extensor carpi ulnaris and radialis)

  • ‘man falls asleep w/ arm under partner’
  • ‘falls asleep w/ arm slung over the back of a chair’
22
Q

Dx

A

Dx = MS plaque

-tissue showing discoloration in the white matter, indicating large area/amount of demyelination

23
Q

(a) Dx
(b) Next step

A

(a) Dx = subarachnoid hemorrhage
- the dread star sign = blood in the circle of Willis
(b) Next step = CTA to find the aneurysm

24
Q

What nerve innervates the

(a) Pec major
(b) Rhomboids

A

(a) Medial and lateral pectoral nerves innervate the pectoralis major
(b) Dorsal scapular nerve (Don’t Shoot Rhinos)

25
Q

What is a tumefactive MS lesion?

A

Tumefactive lesion = atypical presentation of MS w/ large area of demyelination

-often mistaken as neoplasm or abscess

26
Q

Shoulder shrug

(a) Muslce
(b) Nerve

A

Shoulder shrug

(a) Trapezius
(b) CN IX = accessory spinal nerve

27
Q
A

Sargant’s patch = small area of skin w/ sensation provided by axillary nerve

28
Q

Differentiate active vs. old MS lesions

A

Active lesions: hyperintense on MRI and often ring-enhanced w/ contrast (T1)

Old lesions appear hypointense, called ‘black holes’

-evidence of irreversible axonal damage

29
Q

Pt w/ steppage gait- drag toes on the ground while walking

Injury to what nerve?

A

Steppage gait due to weakness in dorsiflexion (toes towards face) of the foot controled by the tibialis anterior innervate by the deep peroneal nerve

30
Q

What nerve provides sensation to the genital region?

A

Pudendal nerve (hence pudendal nerve block in child birth)

31
Q

Sensation to the thumb

A

Palmar surface by median nerve

Dorsal surface by radial nerve

32
Q

What nerve controls

(a) Supination of the hand
(b) Pronation of the hand

A

It’s SUPer RAD to be PreMed

(a) Supination of the hand (palm up to ceiling) by radial nerve
(b) Pronation of the hand (palm to hand) by median nerve

33
Q

What nerve

(a) Flexes the biceps
(b) Flexes the tricep

A

(a) Musculocutaneous nerve
(a) Radial nerve

34
Q

What nerve innervates the diaphragm?

(a) Comes from what nerve roots?

A

Phrenic nerve from C3,4,5

C3,4 and 5 keep you breathing and a live

35
Q

Differentiate Kussmal and Cheyne-Stokes breathing

A

Kussmal breathing = deep and labored breaking associated w/ severe metabolic acidosis seen in DKA and kidney failure

-slow, deep breaths

Cheyne-stokes breathing = fluctuations btwn hyperapnic and apneic episodes

-associated w/ hypoperfusion to respiratory center (ex: herniation)

36
Q

S/p falling off bike- shooting pain from neck down to thumb

-decreased sensation to thumb, decreased bicep reflex, weakness of bicep muscle

Locate the injury

A

Injury = C6 nerve root

From neck to thumb = has to be central (not peripheral)

  • thumb sensation = both median and radial
  • bicep reflex = C5/C6
  • bicep muscle = musculocutaneous nerve (C5/C6)
37
Q

Dx?

A

Finding = cortical ribboning

-indicative of spontaneous Creutzfeldt-Jakob Disease (dismal prognosis)

38
Q

Course of disease in MS

(a) Typical
(b) Atypical

A

Course of disease in MS

(a) 85% have relapsing and remitting course: disease doesn’t progress independently of attacks
- progresses to secondary progressive phase
(b) Atypical: 10% have primary progressive disease where it is progressive at the onset w/o clear relapses

39
Q

S/p unsuccessful clot retrieval for MCA stroke, MRI shows:

What are you worried about?

A

Worried about herniation! Edema/increased ICP causing herniation

edema 2/2 dysfunction of Na/K pumps (2/2 ischemia)

40
Q

Characteritic finding of active MS lesion on MRI w/ contrast

A

T1 w/ constrat of active MS lesion: shows enhancement/hyperintensity (2/2 BBB breakdown) characteristically w/ incomplete ring, often w/ the opening of the ring pointing to the cortex

41
Q

Name the types of herniation

A
  1. Uncal (transtentorial)
  2. Central
  3. Subfalcine
  4. Extracranial
  5. Uptward (transtentorial)
  6. Tonsilar
42
Q
A

Biceps reflex = C5

Brachioradialis = C6

Triceps reflex = C7

43
Q

Hit your elbow on the end of a coffee table, what hand findings might you have?

A

Ulnar nerve runs around the posterior aspect of the medial epicondyle of the humerus thru the cubital tunnel => susceptible to injury when you bang your funny bone

-ulnar nerve injury => numbness to pink and ring finger, cannot make a tight fist

44
Q

(a) Finding
(b) Diagnosis

A

(a) Dawson’s fingers of periventricular MS lesions
(b) Dx = MS

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